[Anesthetic management of cesarean section in a patient with pulmonary embolism due to deep venous thrombosis].
A 28-year-old primipara with pulmonary embolism due to deep venous thrombosis was scheduled for cesarean section under general anesthesia. Her Swan-Ganz catheter and blood gas data revealed pulmonary hypertension and hypoxemia, respectively. Heparin was discontinued 6 hours before operation. A transesophageal echocardiogram (TEE) probe and an inferior vena cava filter were inserted before surgery. Anesthesia was maintained with nitrous oxide and isoflurane in oxygen before delivery, and after delivery with nitrous oxide in oxygen, fentanyl and midazolam. Nitroglycerin and prostaglandin E1 were administered before and after delivery, respectively, to control pulmonary artery pressure, although they were not effective. The anesthetic course was uneventful and her baby's Apgar scores were satisfactory. Mean pulmonary artery pressure (MPAP) gradually decreased after surgery. The inferior vena cava filter may be effective in preventing new pulmonary embolism, and MPAP and TEE monitoring are useful for early detection of pulmonary emboli.
Yabe
M
M
Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School.
Yukioka
H
H
Nomura
T
T
Nakatani
K
K
Nishikawa
K
K
Tatekawa
S
S
Asada
A
A
D000328:Adult; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D002585:Cesarean Section; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D011247:Pregnancy; D011248:Pregnancy Complications; D011655:Pulmonary Embolism / Q000150:complications*; D013924:Thrombophlebitis / Q000150:complications*